306002918-10-30-2024-22-AS-JALE-DAJRCS-20241030125449

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 306002918
Report Date: 10/30/2024
Date Signed: 10/30/2024 12:55:16 PM

Document Has Been Signed on 10/30/2024 12:55 PM - It Cannot Be Edited

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
ORANGE COUNTY RO, 770 THE CITY DR., SUITE 7100
ORANGE, CA 92868

FACILITY NAME:	SUNNY HILLS HOMES		FACILITY NUMBER:	306002918
ADMINISTRATOR/ DIRECTOR:	MARIA/NESTOR MOYA		FACILITY TYPE:	740
ADDRESS:	25402 COSTEAU DRIVE		TELEPHONE:	(949) 370-6639
CITY:	LAGUNA HILLS	STATE: CA	ZIP CODE:	92653
CAPACITY: 5	TOTAL ENROLLED CHILDREN: 0	CENSUS: 4	DATE:	10/30/2024
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME VISIT/ INSPECTION BEGAN:	08:55 AM
MET WITH:	Maria Moya		TIME VISIT/ INSPECTION COMPLETED:	01:05 PM

NARRATIVE
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25	Licensing Program Analyst (LPA) Joseph Alejandre made an unannounced visit to conduct the required annual inspection. LPA met with Administrator Maria Moya and explained the reason for the visit. The facility is a two story home with an attached 2 car garage. The first floor has a living room, eat in kitchen/dining room, 3 resident bedrooms and two bathrooms. The second floor has 3 bedrooms and one bathroom. Residents reside on the first floor. LPA and the Administrator toured the facility. LPA observed the See Something, Say Something poster (PUB 475) poster posted by the front door. LPA observed the kitchen is clean and organized. LPA observed a 2 day perishable and a 7 day non-perishable food supply on hand in the kitchen. Knives are kept locked in a kitchen drawer. Cleaning supplies are stored inaccessible to residents under the kitchen sink. The fire extinguisher in the kitchen is fully charged. LPA observed all the resident rooms had the required furnishings and bed linens. LPA observed both bathrooms on the first floor are clean and operational. Hot water measured 118.5 degrees Fahrenheit. LPA and the Administrator toured the second floor. No obstacles or hazards observed on the second floor. There was no emergency evacuation chair on the second floor. LPA and the Administrator toured the garage and the backyard. The garage is kept locked and used for storage. LPA observed emergency food and water stored in the garage. The backyard has two shaded seating areas to sit outside. No bodies of water observed. The exit gates on each side of the house are operational. No obstacles or hazards observed in the backyard. Smoke detectors/carbon monoxide detectors tested operational. The last emergency drill was conducted on October 10, 2024. LPA reviewed 4 resident files and medications. LPA observed 3 out of 4 residents (Resident 1, 2 and 3) did not have a current appraisal. No other discrepancies observed. LPA reviewed 2 staff files. Both staff members have the required training including CPR/First Aid training. No discrepancies observed. All staff present at the facility are background cleared and associated to the facility. LPA consulted with the Administrator concerning reporting requirements. Deficiencies are being cited per Title 22 Division 6 of the California Code of Regulations. An exit interview was conducted and a copy of the report along with appeal rights was provided.

Sheila Santos	TELEPHONE: (714) 334-2062
Joseph Alejandre	TELEPHONE: 714-705-6018
	DATE: 10/30/2024

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/30/2024

This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)

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Document Has Been Signed on 10/30/2024 12:55 PM - It Cannot Be Edited

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
ORANGE COUNTY RO, 770 THE CITY DR., SUITE 7100
ORANGE, CA 92868

FACILITY NAME: SUNNY HILLS HOMES	FACILITY NUMBER: 306002918
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 10/30/2024

DEFICIENCIES & PLANS OF CORRECTION (POCs)

Type B

Section Cited

CCR

87463(c)

Reappraisals

(c) The licensee shall arrange a meeting with the resident, the resident's representative, if any, appropriate facility staff, and a representative of the resident's home health agency, if any, when there is significant change in the resident's condition, or once every 12 months, whichever occurs first, as specified in Section 87467, Resident Participation in Decision Making. This requirement is not met as evidenced by:
	Deficient Practice Statement
1 2 3 4	Based on record review, the licensee did not comply with the section cited above in 3 out of total count 4 residents, Residents 1, 2 and 3 do not have a current appraisal which poses a potential health, safety or personal rights risk to persons in care.
	POC Due Date: 11/08/2024
	Plan of Correction
1 2 3 4	Licensee agrees to have a new appraisal completed for Residents 1, 2 and 3 and to submit proof to the LPA by the POC due date.

Section Cited


	Deficient Practice Statement
1 2 3 4
	POC Due Date:
	Plan of Correction
1 2 3 4

Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.

SUPERVISOR'S NAME: Sheila Santos	TELEPHONE: (714) 334-2062
LICENSING EVALUATOR NAME: Joseph Alejandre	TELEPHONE: 714-705-6018
LICENSING EVALUATOR SIGNATURE:	DATE: 10/30/2024

I acknowledge receipt of this form and understand my appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/30/2024

LIC809 (FAS) - (06/04)

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